| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,391 |
2,386 |
$113K |
| D0120 |
Periodic oral evaluation - established patient |
3,613 |
3,607 |
$98K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,093 |
593 |
$93K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,869 |
2,857 |
$56K |
| D1120 |
Prophylaxis - child |
1,558 |
1,548 |
$53K |
| D0272 |
Bitewings - two radiographic images |
2,273 |
2,270 |
$48K |
| D1351 |
Sealant - per tooth |
1,058 |
301 |
$29K |
| D2140 |
|
416 |
276 |
$27K |
| D2160 |
|
205 |
128 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
435 |
430 |
$19K |
| D5110 |
|
13 |
12 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
444 |
428 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
51 |
36 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
167 |
164 |
$2K |
| D2950 |
|
16 |
14 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$846.86 |